Table 2.
Protective effect of nutrition, therapy and physical activity on lipid metabolism disorders and CV diseases.
| Dietary Lipids | Physical Activity | Therapy | |
|---|---|---|---|
| Lipid profile | Omega 3 fatty ↗ HDL-c levels [102] | More exercise is associated with smaller HDL-P, fewer large HDL-P and reduced mean HDL-size [130] | TNF-α inhibitors ↗ TC and HDL-c levels [131] |
| Omega 3 fatty ↘ circulating oxidized LDL-c [105,106,107] | Correlation between the intensity of physical activity and HDL levels [132] | 3 months anti-TNF-α treatment ↘ TC levels [133] | |
| DHA and EPA ↗ LDL particle size in hypertensive type 2 diabetes patients and with a hypertriglyceridemia [103,104] | Inverse correlation between the intensity of physical activity and TG and LDL levels [132] | TNF-α inhibition ↗ anti-inflammatory properties of HDL-c [134] | |
| Muscle lipotoxicity | 50µM EPA or DHA ↘ TG, DG and ceramides content [9] | Endurance training ↗ lipid turnover and improve lipid droplets quality [135] | |
| EPA ↗ muscle regeneration capacity of C2C12 muscle cells exposed to palmitate [68] | |||
| Muscle mass and function | Omega 3 during 8 weeks ↗ protein anabolic response in healthy adults [129] | Acute resistance exercise preserved lean body mass, muscle anabolic response and muscle function [136,137] | |
| Omega 3 supplementation ↗ muscle protein rate and phosphorylation of mTORSer2448 and p70S6KThr389 [128] | Long term training program combining strength and endurance ↗ muscle functions [138] | ||
| DHA ↘ muscle protein degradation in C2C12 [125,126] | |||
| CV diseases | 2g omega 3 (46% EPA-38% DHA) ↗ endothelial function and ↘ arterial stiffness [112] | Exercise is associated with a reduced vascular stiffness in RA [139] | 3 months anti-TNF-α treatment improved blood pressure in RA patients [133] |
| Omega 3 ↗ endothelial function in 16 patients with hypertriglyceridemia [105] | Resistance exercise improves endothelial function in type 2 diabetes subjects [140] | 3 months anti-TNF-α treatment improved endothelial function in RA patients [141] | |
| Omega 3 fatty acids ↗ FMD [111] | Moderated-vigourous physical activity ↘ FMD and blood pressure and not affected vascular function [142] | TNF-α inhibitors ↘ the incidence of CV diseases [86] |
Nutrition could have protective effect against perturbations in lipid profile, muscle lipotoxicity, sarcopenia and CV diseases that occur in RA patients. Indeed, an omega 3 supplementation improve lipid profile by increasing HDL-c plasma levels and decreasing TC and LDL-c levels. Moreover, in vitro studies showed that EPA and DHA decreased muscle lipotoxicity and improved muscle protein metabolism, leading to a decrease of CV dysfunctions. This nutritional approach could have a synergic effect with therapy, since TNF-α inhibitors improved lipid profile and decreased CV risk, or with physical activity, which improved lipid profile, muscle metabolism and CV functions. However, no effects of therapy on muscle metabolism has yet been investigated. DG: Diglycerides; DHA: Docosahexaenoic acid; EPA: Eicosapentaenoic acid; HDL: High-density lipoprotein-cholesterol; LDL-c: Low-density lipoprotein-cholesterol; ox-LDL-c: oxidized low-density lipoprotein-cholesterol; RA: Rheumatoid Arthritis; TC: Total cholesterol; TG: Triglycerides; TNF-α: Tumorous Nuclear Factor α.